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KEMH survey paints a grim picture

More than half of staff do not agree the hospital balances safety and productivity

By Gareth Finighan

A survey of employees at King Edward VII Memorial Hospital has delivered a damning indictment on standards of care and staff morale at the facility.

Many healthcare workers feel that patient safety is often neglected in favour of productivity, and that management sometimes fails to provide a climate that promotes the welfare of patients, according to the report.

And alarmingly, almost one third of those surveyed questioned whether patient safety was a priority at the hospital.

The findings are included in a survey of 879 health workers at the hospital conducted in February.

The Patient Safety Culture Survey, obtained by

The Royal Gazette, contains 40 questions designed to assess the views of front line healthcare professionals on how KEMH deals with patient safety.

Although 68 percent of those surveyed agree that they work “in an environment where patient safety is a high priority”, more than half do not agree with the suggestion that the hospital balances the need for patient safety and the need for productivity.

Only around half believe that “good communication flow exists up the chain of command” and that “patient safety decisions are made at the proper level by the most qualified people”.

The survey also suggested that morale among KEMH staff may be at rock bottom.

Just 22.8 percent of respondents feel they are rewarded whenever taking quick action to identify an error, while the vast majority feel it is difficult to question the authority of more senior staff.

But it seems staff are not concerned about the consequences of making a mistake.

Less than 20 percent said they worry about facing disciplinary action should they make a mistake, while less than one third said they would feel ashamed if they made a serious error and colleagues found out about it.

According to the survey, few aspects of patient care at KEMH get the backing of the vast majority of staff.

The answers were tabulated and divided into three 'flag' categories — a green flag where more than 75 percent of respondents gave a positive answer, a yellow flag where positive answers were provided by between 50 percent and 75 percent of respondents, and a red flag where less than half those questioned were able to give a positive answer.

Of the 40 questions asked, 23 were given a yellow flag while there were no green flags, But 17 of the 40 questions did raise a red flag to hospital chiefs.

The poll was conducted on behalf of Accreditation Canada in order to assess patient safety culture at the hospital and provide “road maps” on how to improve that culture.

The findings were last night slammed by healthcare watchdog the Bermuda Health Advocacy Group, which said the results contradicted the “favourable commentary” that was often put forward by hospital bosses.

“To the contrary, the final analyses are very disturbing and truly reveal a serious and systematic problem at BHB concerning patient care,” a group spokeswoman said. “The BHB in recent years has attempted to embellish a cavalier existence with enormous expenditures unrelated to sustaining a business model to enhance the trajectory for patient outcomes.

“Herewith lies a survey providing evidence to substantiate the questionable practices negatively affecting the hospital.

“Moreover, notwithstanding the fact that Accreditation Canada is the same entity responsible for granting BHB with a four year credit rating with emphasis on high honours and exemplary service. How does that work when you have conflicting degrees of exaggeration and information?

“BHAG has recognised that BHB has an incredulous reputation within the community and the trepidation is clearly depicted in the survey results.

“Bermuda can no longer afford to be reclusive or condone the irresponsibility perpetuated by our healthcare institution.

“Demanding accountability is our dutiful right, which must also coincide with the reality that exists in all levels of healthcare operations. The survey is self explanatory and the results highlight the fundamental concerns expressed internally and within the community.

“If BHB is serious about making a key difference in the way it does business than it must first remove the canopy of deception and rise to a position of correctness, transparency and accountability.”

Management says survey is a 'road map' to improving hospital

The Bermuda Hospitals Board last night set out to explain the context of its staff survey, saying that it was a regular tool used to improve services ahead of a planned accreditation review.

“This survey does not measure actual events, so is not a good indicator of how many errors take place,” a BHB spokeswoman said.

“It does, however, measure whether staff feel that their colleagues, managers and senior leaders are supportive of raising patient safety issues, and whether teams use incidents or concerns raised as learning opportunities.”

The spokeswoman added that the new hospital board “is concerned about the negative impact an institutional culture of fear and intimidation can have on patient safety and quality of care”.

“They are currently working with Senior Management to develop strategies to improve this situation, the spokeswoman said.

'Some have begun, others will start in the near future. Some of these include quarterly town hall meetings with all staff, as well as a meeting of randomly selected staff from all levels of BHB with the CEO to discuss areas of concern and jointly look for solutions.

“Monthly rounds by senior management and Board members have also started through different departments.”

The survey is to be used to help develop a “road map of solutions” ahead of an on-site survey in February 2014. A full Accreditation Report following the on-site visit will be made public.

The hospital has recently undergone a review by a team of independent consultants from Canada.

Last night the spokeswoman confirmed that that review was now with the board — and would be made public eventually.

“The Governance Report will be going to Board tomorrow, Wednesday 24 April 2013,” the spokeswoman said.

“Howard Associates submitted their report slightly later than anticipated. The Board will agree the release date at its meeting.

“While we do not want to comment on the findings of the report ahead of its publication, we would like to thank the very many individuals and groups who gave their time to speak to Howard Associates.”

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Published April 24, 2013 at 11:00 am (Updated April 24, 2013 at 11:25 am)

KEMH survey paints a grim picture

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